Incidence and susceptibility of pathogenic bacteria vary between intensive care units within a single hospital: Implications for empiric antibiotic strategies

Nicholas Namias, L. Samiian, D. Nino, E. Shirazi, K. O'Neill, Daniel H Kett, Enrique Ginzburg, M. G. McKenney, Danny Sleeman, S. M. Cohn, R. Roberts, M. G. McKenney, C. J. Yowler, C. Wiles, B. K. Paul

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Background: The purpose of this study was to determine whether the incidence of recovery and patterns of antibiotic susceptibility of pathogenic bacteria vary between intensive care units (ICUs) in a single teaching hospital. Methods: Culture and susceptibility results were collected prospectively for a 3-month period (April through June 1999) in each of the surgical, trauma, and medical ICUs. The number of unique isolates and susceptibility patterns were determined. Susceptibility of isolates among ICUs was compared with χ2. Results: Statistically significant differences between ICUs in susceptibility to various antibiotics were found for Staphylococcus aureus, Enterococcus sp, Acinetobacter sp, Enterobacter sp, Klebsiella sp, and Pseudomonas sp. Notably, vancomycin-resistant Enterococcus was not seen in the medical ICU, whereas it was seen in both the surgical and trauma ICUs. Klebsiella spp resistant to ceftazidime were seen only in the trauma ICU. The aminoglycosides and quinolones had attenuated activity against Pseudomonas sp in the surgical ICU, whereas they remained highly effective in the trauma ICU. Cefazolin had no activity against the Enterobacter sp in either of the surgical ICUs, but was highly effective in the medical ICU. Conclusion: Although the microbiologic results of this study should not be extrapolated to other institutions, the principle is of value. There is variability between ICUs in a single large teaching hospital in susceptibility of bacterial pathogens to various antibiotics. This may have implications in the design of empiric antibiotic strategies and the planning of the hospital formulary. Hospital wide or composite ICU antibiograms are inadequate for planning empiric therapy in the ICU.

Original languageEnglish
Pages (from-to)638-646
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume49
Issue number4
StatePublished - Jan 1 2000

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Intensive Care Units
Anti-Bacterial Agents
Bacteria
Incidence
Critical Care
Enterobacter
Klebsiella
Wounds and Injuries
Pseudomonas
Teaching Hospitals
Hospital Formularies
Cefazolin
Acinetobacter
Ceftazidime
Quinolones
Enterococcus
Microbial Sensitivity Tests
Aminoglycosides
Staphylococcus aureus

Keywords

  • Antibiotic resistance
  • Antibiotics
  • Critical care
  • Surgery
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Incidence and susceptibility of pathogenic bacteria vary between intensive care units within a single hospital : Implications for empiric antibiotic strategies. / Namias, Nicholas; Samiian, L.; Nino, D.; Shirazi, E.; O'Neill, K.; Kett, Daniel H; Ginzburg, Enrique; McKenney, M. G.; Sleeman, Danny; Cohn, S. M.; Roberts, R.; McKenney, M. G.; Yowler, C. J.; Wiles, C.; Paul, B. K.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 49, No. 4, 01.01.2000, p. 638-646.

Research output: Contribution to journalArticle

Namias, Nicholas ; Samiian, L. ; Nino, D. ; Shirazi, E. ; O'Neill, K. ; Kett, Daniel H ; Ginzburg, Enrique ; McKenney, M. G. ; Sleeman, Danny ; Cohn, S. M. ; Roberts, R. ; McKenney, M. G. ; Yowler, C. J. ; Wiles, C. ; Paul, B. K. / Incidence and susceptibility of pathogenic bacteria vary between intensive care units within a single hospital : Implications for empiric antibiotic strategies. In: Journal of Trauma - Injury, Infection and Critical Care. 2000 ; Vol. 49, No. 4. pp. 638-646.
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abstract = "Background: The purpose of this study was to determine whether the incidence of recovery and patterns of antibiotic susceptibility of pathogenic bacteria vary between intensive care units (ICUs) in a single teaching hospital. Methods: Culture and susceptibility results were collected prospectively for a 3-month period (April through June 1999) in each of the surgical, trauma, and medical ICUs. The number of unique isolates and susceptibility patterns were determined. Susceptibility of isolates among ICUs was compared with χ2. Results: Statistically significant differences between ICUs in susceptibility to various antibiotics were found for Staphylococcus aureus, Enterococcus sp, Acinetobacter sp, Enterobacter sp, Klebsiella sp, and Pseudomonas sp. Notably, vancomycin-resistant Enterococcus was not seen in the medical ICU, whereas it was seen in both the surgical and trauma ICUs. Klebsiella spp resistant to ceftazidime were seen only in the trauma ICU. The aminoglycosides and quinolones had attenuated activity against Pseudomonas sp in the surgical ICU, whereas they remained highly effective in the trauma ICU. Cefazolin had no activity against the Enterobacter sp in either of the surgical ICUs, but was highly effective in the medical ICU. Conclusion: Although the microbiologic results of this study should not be extrapolated to other institutions, the principle is of value. There is variability between ICUs in a single large teaching hospital in susceptibility of bacterial pathogens to various antibiotics. This may have implications in the design of empiric antibiotic strategies and the planning of the hospital formulary. Hospital wide or composite ICU antibiograms are inadequate for planning empiric therapy in the ICU.",
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T1 - Incidence and susceptibility of pathogenic bacteria vary between intensive care units within a single hospital

T2 - Implications for empiric antibiotic strategies

AU - Namias, Nicholas

AU - Samiian, L.

AU - Nino, D.

AU - Shirazi, E.

AU - O'Neill, K.

AU - Kett, Daniel H

AU - Ginzburg, Enrique

AU - McKenney, M. G.

AU - Sleeman, Danny

AU - Cohn, S. M.

AU - Roberts, R.

AU - McKenney, M. G.

AU - Yowler, C. J.

AU - Wiles, C.

AU - Paul, B. K.

PY - 2000/1/1

Y1 - 2000/1/1

N2 - Background: The purpose of this study was to determine whether the incidence of recovery and patterns of antibiotic susceptibility of pathogenic bacteria vary between intensive care units (ICUs) in a single teaching hospital. Methods: Culture and susceptibility results were collected prospectively for a 3-month period (April through June 1999) in each of the surgical, trauma, and medical ICUs. The number of unique isolates and susceptibility patterns were determined. Susceptibility of isolates among ICUs was compared with χ2. Results: Statistically significant differences between ICUs in susceptibility to various antibiotics were found for Staphylococcus aureus, Enterococcus sp, Acinetobacter sp, Enterobacter sp, Klebsiella sp, and Pseudomonas sp. Notably, vancomycin-resistant Enterococcus was not seen in the medical ICU, whereas it was seen in both the surgical and trauma ICUs. Klebsiella spp resistant to ceftazidime were seen only in the trauma ICU. The aminoglycosides and quinolones had attenuated activity against Pseudomonas sp in the surgical ICU, whereas they remained highly effective in the trauma ICU. Cefazolin had no activity against the Enterobacter sp in either of the surgical ICUs, but was highly effective in the medical ICU. Conclusion: Although the microbiologic results of this study should not be extrapolated to other institutions, the principle is of value. There is variability between ICUs in a single large teaching hospital in susceptibility of bacterial pathogens to various antibiotics. This may have implications in the design of empiric antibiotic strategies and the planning of the hospital formulary. Hospital wide or composite ICU antibiograms are inadequate for planning empiric therapy in the ICU.

AB - Background: The purpose of this study was to determine whether the incidence of recovery and patterns of antibiotic susceptibility of pathogenic bacteria vary between intensive care units (ICUs) in a single teaching hospital. Methods: Culture and susceptibility results were collected prospectively for a 3-month period (April through June 1999) in each of the surgical, trauma, and medical ICUs. The number of unique isolates and susceptibility patterns were determined. Susceptibility of isolates among ICUs was compared with χ2. Results: Statistically significant differences between ICUs in susceptibility to various antibiotics were found for Staphylococcus aureus, Enterococcus sp, Acinetobacter sp, Enterobacter sp, Klebsiella sp, and Pseudomonas sp. Notably, vancomycin-resistant Enterococcus was not seen in the medical ICU, whereas it was seen in both the surgical and trauma ICUs. Klebsiella spp resistant to ceftazidime were seen only in the trauma ICU. The aminoglycosides and quinolones had attenuated activity against Pseudomonas sp in the surgical ICU, whereas they remained highly effective in the trauma ICU. Cefazolin had no activity against the Enterobacter sp in either of the surgical ICUs, but was highly effective in the medical ICU. Conclusion: Although the microbiologic results of this study should not be extrapolated to other institutions, the principle is of value. There is variability between ICUs in a single large teaching hospital in susceptibility of bacterial pathogens to various antibiotics. This may have implications in the design of empiric antibiotic strategies and the planning of the hospital formulary. Hospital wide or composite ICU antibiograms are inadequate for planning empiric therapy in the ICU.

KW - Antibiotic resistance

KW - Antibiotics

KW - Critical care

KW - Surgery

KW - Trauma

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